EP3135238B1

EP3135238B1 - Methods and apparatus for dental implantation

Info

Publication number: EP3135238B1
Application number: EP16194024.2A
Authority: EP
Inventors: Uri Sonenfeld; Uri Alon
Original assignee: Image Navigation Ltd
Current assignee: Image Navigation Ltd
Priority date: 2005-04-18
Filing date: 2006-04-11
Publication date: 2019-05-29
Anticipated expiration: 2026-04-11
Also published as: EP1898826A2; EP1898826B1; EP3135238A1; US8172573B2; WO2006111964A2; WO2006111964A3; EP1898826A4; US20080171305A1

Description

FIELD OF THE INVENTION

The present invention relates to apparatus for dental implantation.

BACKGROUND OF THE INVENTION

The following patent documents are believed to represent the current state of the art:

U.S. Patent Nos.: 6,902,401 ; 6,814,575 ; 6,382,977 ; 6,315,555 ; 5,927,982 ; 6,905,336 ; 5,993,211 ; 6,447,296 ; 6,640,128 ; 6,932,823 ; 6,497,134 ; 5,856,844 ; 6,402,707 ; 6,340,367 ; 5,867,696 ; 5,697,779 ; 7,006,085 and 6,434,507 ; and
Applicant/Assignee's Published PCT Application No. WO02/096261 .

WO 02/096261 , showing the preamble of claim 1, discloses image guided implanatology methods for patients with a full set of teeth (i.e. are not partially or fully edentulous). DE 19902273A1 discloses a device for intraoperative determination of placement of dental implants. WO02/07630299 discloses a device and method for removing material or tissue or for working material or tissue in which a first marking support with markings is arranged on a handpiece with the effector and the handpiece is connected to a control unit and a second marking support with markings is attached to the material object or tissue object.

SUMMARY OF THE INVENTION

There is provided in accordance with a preferred embodiment of the present invention an apparatus for implanting a tooth implant in a patient, as in claim 1, comprising: an attachment element configured for coupling to a patient tracking device and for receipt of either at least one fiducial marker or a fiducial carrier that carries the at least one fiducial marker, wherein said attachment element is configured to be removably and replaceably attachable to said patient's teeth at a precisely repeatable position with respect to said patient's teeth such that whenever said attachment element is remounted onto said teeth, the fiducial carrier or at least one fiducial marker regains a same spatial position relative to the patient's teeth or jaw bone, characterized by the attachment element comprising a precise-tooth-shape-retaining material, the precise-tooth-shape-retaining material suitable for molding and hardening into a rigid state and useful for exclusively chair-side configuring of at least a portion of the attachment element to match said patient's teeth, wherein the attachment element also comprises a multipurpose holder for holding the precise-tooth-shape-retaining material, the multipurpose holder also having a channel defining portion for connecting to the patient tracking device, wherein the precise-tooth-shape-retaining material is configured to fit inside a trough-like portion of the multipurpose holder.
In accordance with a preferred embodiment the at least one fiducial marker, said at least one fiducial marker configured to provide registration between said at least one fiducial marker and said patient's jaw bone, said registration used to guide an implant drilling assembly.
In accordance with a preferred embodiment, the attachment element is configured to accept a mounting rod of the patient tracking device.
In accordance with a preferred embodiment, the multipurpose holder is integrally formed with a channel-defining portion.
In accordance with a further preferred embodiment, the precise-tooth-shape-retaining material is configured to mate with at least two teeth of said patient's teeth.
In accordance with a further preferred embodiment, the precise-tooth-shape-retaining material is configured to mate with at least three teeth of said patient's teeth.
In accordance with a still further preferred embodiment, the precise-tooth-shape-retaining material is configured to mate with at least four teeth of said patient's teeth.
In accordance with a still further preferred embodiment, said patient tracking device, wherein said patient tracking device is configured for use with a tracking camera to provide tracking of at least one of (i) position and (ii) movement of said patient during implantation of said tooth implant.
In accordance with a further preferred embodiment, the apparatus further comprises a tracking system including at least one IR emitter configured for providing tracking of motions of said patient during implantation of said tooth implant.
In accordance with a further preferred embodiment, the tracking system also includes the implant drilling assembly having at least one IR emitter for providing tracking of motions of a dental surgeon during implantation of said tooth implant.
In accordance with a further preferred embodiment, the apparatus further comprises the implant drilling assembly, wherein the implant drilling assembly is a dental surgery device configured to provide tracking of motions of a dental surgeon during implantation of said tooth implant.

BRIEF DESCRIPTION OF THE DRAWINGS

The present invention will be understood and appreciated more fully from the following detailed description, taken in conjunction with the drawings in which: Figs. IA, IB, 1C, ID, IE, IF, IG, IH, II, IJ, IK, IL, IM, IN and 10 are simplified pictorial illustrations of various stages in a method of placing an implant on a fully edentulous patient in accordance with an exemplary embodiment; and Figs. 2A, 2B, 2C, 2D, 2E, 2F, 2G, 2H, 2I and 2J are simplified pictorial illustrations of various stages in a method of placing an implant on a partially edentulous patient in accordance with the present invention.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

Reference is now made to Figs. IA, IB, 1C, ID, IE, IF, IG, IH, II, IJ, IK, IL, IM, IN and 10, which are simplified pictorial illustrations of various stages in a method of placing an implant on an at least partially edentulous patient in accordance with an exemplary embodiment. Figs. IA - 10 describe a method for placing a tooth implant in an at least partially edentulous patient including the steps of anchoring at least one attachment element in a patient's jaw bone, removably and replaceably mounting a carrier bearing at least one fiducial marker onto the at least one attachment element in a precisely repeatable position with respect to the patient's jaw bone, employing the carrier for providing registration between the at least one fiducial marker and the patient's jaw bone and placing the tooth implant by employing a tracking system which uses the registration to guide a drilling assembly.
Prior to the stage illustrated in Fig. IA, a conventional impression is taken of the patient's jaw. The impression is employed conventionally in a dental laboratory to create a conventional temporary base and rim matching the patient's jaw. The temporary base and rim is employed as described hereinbelow.
Referring now specifically to Fig. IA, it is seen that the dentist has inserted at least one, preferably three attachment elements, each preferably including an anchor portion and an attachment portion, in a patient's jaw bone. In the illustrated embodiment of Figs. IA - 10, the attachment elements are preferably bone screws 100 which include a tapered, threaded screw portion 102 and a spherical head 104. Preferably, the bone screws 100 are inserted by drilling into the patient's jaw bone to a depth of approximately one-half of the length of screw portion 102 and then screwing in the bone screws 100, typically by the use of a ratchet wrench 106.
It is appreciated that due to the provision of the spherical head 104, the longitudinal axes of the bone screws 100, here designated by reference numeral 108, need not necessarily be parallel, although it is desirable that they be as parallel to each other as possible. It is preferred that the distribution of the bone screws 100 be generally as illustrated, with a center bone screw 100 preferably being located at the midline of the jaw and two additional bone screws 100 being located posterior to the most posterior of the implants to be placed. As seen in Fig. IB, impression caps 110 are preferably removably placed onto the spherical heads 104 of the bone screws 100, preferably by snap-fit engagement therewith. The positioning of the impression caps 110 on the spherical heads 104 is preferably such that top surfaces 112 thereof all lie in a common plane. Referring now to Fig. 1C, it is seen that an impression is taken of the patient's jaw, having the impression caps 110 in place therein. The apparatus and methodology for taking the impression may be entirely conventional and may include conventional impression material 114, such as IMPREGUM SE, commercially available from 3M, and the temporary base and rim earlier prepared for the patient, which is employed as a custom tray 116.
It is noted that preferably the impression caps 110 adhere to the impression material 114 and thus form part of the impression, which is designated by reference numeral 118.
Preferably, following the step shown in Fig. 1C, bite registration is carried out in a conventional manner.
At this stage, a conventional impression preferably is taken of the antagonist jaw.
Referring now to Fig. ID, it is seen that impression 118 is fitted with screw analogs 120 in an orientation as shown. The screw analogs 120 preferably include a spherical head analog 124, which is identical to spherical head 104 as well as a stem
126. The spherical head analogs 124 preferably snap-fit into impression caps 110, as shown. The impression 118, together with screw analogs 120, preferably is poured with plaster to form a model 130 of the patient's jaw wherein the spherical head analogs 124 protrude from the alveolar crest portion 132 of model 130 and the stems 126 are embedded in the model 130.
Referring now to Fig. IE, at this stage model 130 and a conventional model 134 of the antagonist jaw are placed in an articulator 136 and radio-opaque artificial teeth 138 are removably positioned on alveolar crest portion 132 of model 130.
Turning to Fig. IF, it is seen that the radio-opaque teeth, here designated by reference numeral 140 and 142, which are adjacent the spherical head analog 124 positioned along the mid line of the jaw, are removed, retentive caps 144 are snap fitted onto spherical head analogs 124 and a mounting portion 150 forming part of a fiducial marker carrier assembly (not shown) is fitted such that apertured spherical head engagement portions 152 thereof are placed over corresponding retentive caps 144, as shown. An adhesive 153, preferably pattern resin, commercially available from GC America Inc. of Alsip, IL, USA, is placed over each apertured spherical head engagement portion 152 and corresponding retentive cap 144, in order to fixedly attach the mounting portion 150 to the retentive caps 144, such that the mounting portion 150 is securely removeably mounted in place on the spherical head analogs 124.
Preferably, as seen in Fig. IF, the mounting portion 150 is formed of a mounting element 154 which includes a plurality of bores 155 configured for is selectable positioning with respect to apertured spherical head engagement portion 152 which are typically removably fixed thereto by screws 156, in order to enhance ease of fitting the mounting portion 150 to the jaw of a patient and to the attachment elements inserted therein. The mounting portion 150 preferably also includes a tracking device mounting rod 158. Reference is now made to Fig. IG, which shows placement of a fiducial carrier portion 160 of the fiducial marker carrier assembly (not shown) onto the mounting portion 150 while the mounting portion 150 remains attached to the model 130. The fiducial carrier portion 160 is commercially available from Denx Ltd. of Jerusalem, Israel, under catalog number AIG 3110. A plurality of fiducial markers 162, preferably nine in number and in the form of a ceramic sphere having a diameter of 3mm are mounted on the carrier portion 160 at precise locations thereat.
Referring now to Fig. IH, it is seen that carrier portion 160 is adhesively fixed to mounting portion 150, preferably adjacent apertured spherical head engagement portions 152 by additional application thereat of an adhesive 164, preferably pattern resin, commercially available from GC America Inc. of Alsip, IL, USA. Thereafter, the carrier portion 160 is adhered to the radio-opaque artificial teeth 138 by means an adhesive 165, preferably UNIFAST TRAD, commercially available from GC America Inc. of Alsip, IL, USA.
Reference is now made to Fig. II, which shows a CT imagable registration assembly 166, including the adhesively adhered mounting portion 150 together with retentive caps 144, carrier portion 160 and radio-opaque artificial teeth 138 having been removed from model 130 and being inserted into a patient's mouth. The assembly 166 is secured in the patient's mouth by snap fitting the retentive caps 144, fixed by adhesive 153 to mounting portion 150, onto spherical heads 104 of bone screws 100.
Fig. IJ shows the patient, having the assembly 166, including adhesively adhered mounting portion 150, carrier portion 160 and radio-opaque artificial teeth 138 being snap fitted onto spherical heads 104 of bone screws 100, inserted in the patient's mouth, undergoing CT imaging
Fig. IK illustrates an image produced by the CT imaging of Fig. IJ, being employed by a dental surgeon in computerized planning of an implant procedure. The resulting CT images establish three-dimensional spatial registration between the fiducial markers 162 and the patient's jaw.
Fig. IL illustrates attachment of a patient tracking device 170 to the adhesively adhered mounting portion 150, carrier portion 160 and radio-opaque artificial teeth 138. Patient tracking device 170 is preferably a patient tracker, commercially available from Denx Ltd. under catalog number AIG 3302, and is mounted onto tracking device mounting rod 158. The patient tracking device 170 preferably includes a plurality of IR emitters 172, typically seven in number.
Three-dimensional spatial registration is then established between the IR emitters 172 of tracking device 170 and the fiducial markers 162 on carrier 160. This is preferably done by employing a conventional IR trackable handpiece 180, commercially available from Denx Ltd. under catalog number AIG 2400, and is described in applicant/assignee's published PCT application No. WO02/096261 , which includes a multiplicity of IR emitters 182, typically 14 in number, and a three-dimensional IR imager 184, such as a tracking camera which is commercially available from Denx Ltd. under catalog number ATR0014. Typically, as shown in Fig. IL, an operator places a tip of a contact bit 186 mounted in handpiece 180, onto each fiducial marker 162 and images the three dimensional spatial relationship between that IR emitters 172 of the tracking device 170 and the IR emitters 182 of the handpiece 180, thus establishing the three-dimensional spatial relationship between that fiducial marker 162 and IR emitters 172 of the tracking device 170. This process is carried out sequentially for each of the fiducial markers 162, thus establishing the fixed three-dimensional spatial relationship between the patient tracking device 170 and the patient's jaw. Reference is now made to Fig. IM, which shows separating the fiducial carrier 160 and artificial radio-opaque teeth 138 adhered thereto from mounting portion 150. This is carried out by cutting the adhesive 164, as with a cutting disk 188.
Referring now to Fig. IN, it is seen that the mounting portion 150 which is fixedly coupled to the patient tracking device 170, is placed in the patient's mouth, preferably by snap-fitting retentive caps 144 (Fig. IF) onto spherical heads 104 (Fig. IA) of bone screws 100. Reference is now made to Fig. 10, which illustrates implant surgery carried out in accordance with an exemplary embodiment wherein the surgeon is guided by a display 190 which shows, in real time, the location of a drill bit 192 mounted onto handpiece 180 in relationship to the patient's jaw overlaid on a planned drilling trajectory, which is preferably prepared during an implant planning stage described hereinabove with reference to Fig. IK.
Reference is now made Figs. 2A, 2B, 2C, 2D, 2E, 2F, 2G, 2H, 2I and 2J, which are simplified pictorial illustrations of various stages in a method of placing an implant on a partially edentulous patient in accordance with the present invention.
Figs. 2A - 2J describe a method for placing a tooth implant in a patient comprising the steps of attaching at least one attachment element to a patient's teeth by exclusively chair-side configuring of at least a portion of the at least one attachment element to match the patient's teeth, mounting a carrier bearing at least one fiducial marker onto the attachment element, employing the carrier for providing registration between the at least one fiducial marker and the patient's jaw bone and placing the tooth implant by employing a tracking system which uses the registration to guide a drilling assembly.
Additionally in accordance with the present invention, Figs. 2A - 2J describe a method for placing a tooth implant in a patient comprising the steps of exclusively chair-side attaching at least one radio-opaque tooth shape representation element to a patient's jaw, mounting a carrier bearing at least one fiducial marker onto the patient's jaw, employing the carrier and the at least one radio- opaque tooth shape representation element for providing registration between the at least one fiducial marker, the at least one radio-opaque tooth shape representation element and the patient's jaw bone and implanting the tooth implant by employing a tracking system which uses the registration to guide a drilling assembly.
Referring now specifically to Fig. 2A, it is seen that a dentist is preparing a multipurpose tooth engagement assembly 200 which is seen to be associated with a fiducial carrier 202, preferably being attached thereto by a screw 204. Fiducial carrier 202 is commercially available from Denx Ltd. of Jerusalem, Israel, under catalog number AIG 3110. A plurality of fiducial markers 206, preferably nine in number and in the form of a ceramic sphere having a diameter of 3mm are mounted on the carrier 202 at precise locations thereat. Multipurpose tooth engagement assembly 200 preferably includes a multipurpose tooth engagement element 208, which preferably comprises a trough-like portion 210 which preferably is integrally formed with a channel-defining portion 212 lying alongside the trough-like portion 210. The trough-like portion 210 preferably includes a base 214 which has a generally straight edge 216 and a somewhat curved edge 218. Extending in a plane which is inclined outwardly with respect to base 214 along generally straight edge 216 is a first, generally straight, trough wall 220, which lies adjacent channel-defining portion 212. Extending in a plane which is inclined outwardly with respect to base 214 along curved edge 218 is a curved trough wall 222. Trough wall 222 is of a height which is approximately one half of the height of straight trough wall 220.
Channel defining portion 212 preferably includes a base 224 which is coplanar with base 214, an inner side wall 226 which is at least partially common with trough wall 220, an outer side wall 228 and a wall 230, which is generally parallel to and spaced from base 224. Formed in base 214 are a plurality of recesses 232 for retaining impression material 234, which is preferably ZIOO restorative, commercially available from 3M, and a threaded aperture 236 which accommodates screw 204. Trough walls 220 and 222 are preferably formed with a plurality of apertures 240.
Base 224 and walls 226, 228 and 230 of channel defining portion 212 together define a channel 242 which is configured to accept a mounting rod of a patient tracking device, as described hereinbelow with reference to Fig. 2H. An aperture 244 is preferably formed in wall 228 and communicates with channel 242 for accommodating a securing screw which threadably engages the mounting rod, as described hereinbelow with reference to Fig. 2H.
It is appreciated that various types and configurations of multipurpose tooth engagement elements and assemblies may be provided to conform to various regions of a patient's jaws.
It is seen that an impression is taken of part of the patient's teeth, using impression material 234, at a region preferably as far as possible from an intended implantation site. The impression material 234 is hardened while on the patient's teeth, preferably by light curing. It is appreciated that since the impression material 234 is hardened and it is sought to be able to repeatedly remove and replace the impression onto the patient's teeth with a high level of accuracy, care must be taken to prevent the impression material from entering interstices of the patient's teeth, as by blocking with a suitable filler material (not shown), such as ORASEAL(R) putty, commercially available from Ultradent Products Inc. of Jordan, Utah USA. Alternatively, should the impression material have entered undercuts or interstices of the patient's teeth, those portions of the impression may be excised by cutting using conventional dental tools.
Referring now to Fig. 2B, it is seen that following hardening of the impression the multipurpose tooth engagement assembly 200 and the associated fiducial carrier 202 are removed from the mouth of the patient and a conventional radiolucent impression material 246, such as IMPREGUM SE, commercially available from 3M, is applied to the intended implantation site.
As seen in Fig. 2C, the patient is required to bite down on the impression material 246, prior to hardening thereof, thereby to impress on material 246 the shape of the antagonist teeth, as shown at reference numeral 248. The impression material 246 is allowed to harden to define a radiolucent impression 249, prior to the patient opening his mouth.
Reference is now made to Fig. 2D, which shows injection of a hardenable radio-opaque material 250, such as LUXATEMP (R) fluorescence, commercially available from Zenith/DMG of Englewood, NJ, USA, into the impression 249. The material 250 is allowed to harden, thus providing a radio-opaque model 252 of relevant surfaces of the antagonist teeth. Referring now to Fig. 2E, it is seen that the multipurpose tooth engagement assembly 200 and the associated fiducial carrier 202 are returned to the mouth of the patient and precisely repositioned therein such that the fiducial carrier 202 overlies, inter alia, the radio-opaque model 252 and the impression 249. Reference is now made to Fig. 2F, which shows a CT imagable registration assembly 260, including the multipurpose tooth engagement assembly 200, the associated fiducial carrier 202, the radio-opaque model 252 and the radiolucent impression 249 inserted into a patient's mouth and secured therein by the patient tightly closing his jaws during CT imaging. Following CT imaging the assembly 260 is removed from the patient's mouth.
Fig. 2G illustrates an image produced by the CT imaging of Fig. 2F, being employed by a dental surgeon in computerized planning of an implant procedure. The resulting CT images establish three-dimensional spatial registration between the fiducial markers 206 and the patient's jaw. Fig. 2H illustrates attachment of a patient tracking device 270 to the multipurpose tooth engagement element 208 by inserting a rod 272 of device 270 into channel 242 and securing it by means of a securing screw (not shown), which extends through aperture 244. Patient tracking device 270 is preferably a patient tracker, commercially available from Denx Ltd. under catalog number AIG 3302. The patient tracking device 270 preferably includes a plurality of IR emitters 276, typically seven in number.
Three-dimensional spatial registration is then established between the IR emitters 276 of tracking device 270 and the fiducial markers 206 on carrier 202. This is preferably done by employing an IR trackable handpiece 280, commercially available from Denx Ltd. under catalog number AIG 2400, and is described in applicant/assignee's published PCT application No. WO02/096261 , which includes a multiplicity of IR emitters 282, typically 14 in number, and a three-dimensional IR imager 284, such as a tracking camera which is commercially available from Denx Ltd. under catalog number ATR0014. Typically, as shown, an operator places a tip of a contact bit 286 mounted in handpiece 280, onto each fiducial marker 206 and images the three dimensional spatial relationship between that IR emitters 276 of the tracking device 270 and the IR emitters 282 of the handpiece 280, thus establishing the three-dimensional spatial relationship between that fiducial marker 206 and IR emitters 276 of the tracking device 270. This process is carried out sequentially for each of the fiducial markers 206, thus establishing the fixed three-dimensional spatial relationship between the patient tracking device 270 and the patient's jaw.
Reference is now made to Fig. 2I, which illustrates separation of the multipurpose tooth engagement element 208 from fiducial carrier 202, as by removal of screw 204. The multipurpose tooth engagement element 208 is then adhesively and precisely mounted in the patient's mouth, preferably by use of conventional impression material 286, such as IMPREGUM SE applied to sides of the patient's teeth.
Reference is now made to Fig. 2J, which illustrates implant surgery carried out in accordance with the present invention wherein the surgeon is guided by a display 290 which shows, in real time, the location of a drill bit 292 mounted onto handpiece 280 in relationship to the patient's jaw overlaid on a planned drilling trajectory, which is preferably prepared during an implant planning stage described hereinabove with reference to Fig. 2G.

Claims

An apparatus for implanting a tooth implant in a patient, comprising:
an attachment element (200) configured for coupling to a patient tracking device (270) and for receipt of either at least one fiducial marker (206) or a fiducial carrier (202) that carries the at least one fiducial marker (206),

wherein said attachment element (200) is configured to be removably and replaceably attachable to said patient's teeth at a precisely repeatable position with respect to said patient's teeth such that whenever said attachment element (200) is remounted onto said teeth, the fiducial carrier (202) or at least one fiducial marker (206) regains a same spatial position relative to the patient's teeth or jaw bone, wherein

the attachment element (200) comprises a precise-tooth-shape-retaining material (234), the precise-tooth-shape-retaining material (234) suitable for molding and hardening into a rigid state and useful for exclusively chair-side configuring of at least a portion of the attachment element to match said patient's teeth, characterized in that

the attachment element (200) also comprises a multipurpose holder (208) for holding the precise-tooth-shape-retaining material (234), the multipurpose holder (208) also having a channel-defining portion (212) for connecting to the patient tracking device (270), wherein

the precise-tooth-shape-retaining material (234) is configured to fit inside a trough-like portion (210) of the multipurpose holder (208).
The apparatus according to claim 1, further comprising the at least one fiducial marker (206), said at least one fiducial marker (206) configured to provide registration between said at least one fiducial marker (206) and said patient's jaw bone, said registration used to guide an implant drilling assembly (280).
The apparatus of any of claims 1-2, wherein the attachment element (200) is configured to accept a mounting rod of the patient tracking device (270).
The apparatus of any of claims 1-3, wherein the multipurpose holder (208) is integrally formed with a channel-defining portion (212).
The apparatus of any of claims 1-4, wherein the precise-tooth-shape-retaining material (234) is configured to mate with at least two teeth of said patient's teeth.
The apparatus of any of claims 1-5, wherein the precise-tooth-shape-retaining material (234) is configured to mate with at least three teeth of said patient's teeth.
The apparatus of any of claims 1-6, wherein the precise-tooth-shape-retaining material (234) is configured to mate with at least four teeth of said patient's teeth.
The apparatus of any of claims 1-7, further comprising said patient tracking device (270), wherein said patient tracking device (270) is configured for use with a tracking camera (284) to provide tracking of at least one of (i) position and (ii) movement of said patient during implantation of said tooth implant.
The apparatus according to any of claims 1-8 and also comprising a tracking system including at least one IR emitter (276) configured for providing tracking of motions of said patient during implantation of said tooth implant.
The apparatus according to any of claims 1-9, wherein the tracking system also includes the implant drilling assembly (280) having at least one IR emitter (282) for providing tracking of motions of a dental surgeon during implantation of said tooth implant.
The apparatus according to any of claims 1-10, further comprising the implant drilling assembly (280), wherein the implant drilling assembly (280) is a dental surgery device (280) configured to provide tracking of motions of a dental surgeon during implantation of said tooth implant.